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Offlinemorrowasted
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Re: Viral outbreak in China [Re: The Blind Ass]
    #26587003 - 04/08/20 06:26 PM (3 years, 10 months ago)

https://www.cnbc.com/2020/04/06/who-says-theres-a-global-shortfall-of-5point9-million-nurses-as-world-battles-coronavirus-pandemic.html


WHO says there’s a global shortfall of 5.9 million nurses as world battles coronavirus pandemic


get in, the water's warm


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Offlinelowbrow
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Re: Viral outbreak in China [Re: tyrannicalrex]
    #26587007 - 04/08/20 06:28 PM (3 years, 10 months ago)

Quote:

tyrannicalrex said:
Quote:

lowbrow said:
Trump never said the corona virus was a hoax.




He didn't? Are these quotes not true?





https://headtopics.com/us/trump-says-the-coronavirus-is-the-democrats-new-hoax-11591653


Trump says the coronavirus is the Democrats' 'new hoax'

President Donald Trump spoke on Friday from a campaign rally in North Charleston, South Carolina.

https://www.quora.com/Is-Donald-Trumps-assertion-coronavirus-Democrats-new-hoax-to-undermine-his-administration-grounds-for-legislated-psychiatric-determination-of-his-competency-to-hold-office





    Donald Trump referred to the coronavirus as the Democrats’ “new hoax” at his rally last night. How do you interpret that assertion?




T, none of your links went anywhere.

Here’s mine.

https://www.snopes.com/fact-check/trump-coronavirus-rally-remark/

Trump referred to the way they were going to treat the president’s response as their new hoax.

Quote:

tyrannicalrex said:

Donald Trump referred to the coronavirus as the Democrats’ “new hoax” at his rally last night. How do you interpret that assertion?




If you have a link to this one I’d like to see it, otherwise, no big deal, I’ll look it up myself.


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Amanita86 said:
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Invisibletyrannicalrex
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Re: Viral outbreak in China [Re: lowbrow]
    #26587009 - 04/08/20 06:29 PM (3 years, 10 months ago)



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InvisibleThe Blind Ass
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Re: Viral outbreak in China [Re: lowbrow]
    #26587013 - 04/08/20 06:32 PM (3 years, 10 months ago)

Here’s to rooting for our species
:rabble:  :protest:  :headbang3:  :cheers:  :goodluck:  :iloveyou:


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Give me Liberty caps -or- give me Death caps


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InvisibleShroomerInTheRye
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Re: Viral outbreak in China [Re: The Blind Ass]
    #26587020 - 04/08/20 06:33 PM (3 years, 10 months ago)

https://www.cnn.com/2020/04/08/us/california-nursing-home-evacuated/index.html

Dozens of patients from a nursing home in Southern California were evacuated to other centers Wednesday after employees stopped showing up for work, officials say.

Magnolia Rehabilitation and Skilled Nursing Center in Riverside, California has been hit hard by coronavirus, with at least 34 of 84 patients and five staff members testing positive, according to a news release from Riverside County Public Health Department.

Wednesday is the second day in a row employees didn't show up to care for patients. Thirty-three nurses were brought in by Riverside University Health and Kaiser Permanente to fill in on Tuesday, the release states.

Noting that rehab centers and nursing facilities present a particular challenge due to the age and health conditions of the residents, the county's health department said the centers receiving patients will follow strict Covid-19 containment procedures.


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InvisibleThe Blind Ass
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Re: Viral outbreak in China [Re: ShroomerInTheRye]
    #26587025 - 04/08/20 06:35 PM (3 years, 10 months ago)

That’s a damn shame.  Fuck, that breaks my heart.  :dontdothat:


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InvisibleCrazy_Horse
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Re: Viral outbreak in China [Re: ShroomerInTheRye]
    #26587031 - 04/08/20 06:37 PM (3 years, 10 months ago)

https://www.usnews.com/news/best-states/indiana/articles/2020-04-06/indiana-virus-death-toll-now-139-total-cases-near-5-000

Quote:

Eleven residents of a central Indiana nursing home have died from COVID-19




Old people are fucked.


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InvisiblefeeversM
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Re: Viral outbreak in China [Re: ShroomerInTheRye]
    #26587035 - 04/08/20 06:38 PM (3 years, 10 months ago)

This was a nursing home near me the other day. Our governor sent in the national guard to test everyone.

Nursing homes that require hands-on care are in really rough shape right now.



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InvisibleShroomerInTheRye
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Re: Viral outbreak in China [Re: feevers]
    #26587039 - 04/08/20 06:39 PM (3 years, 10 months ago)

Good God, just to up and abandon your post and leave old people to die.....holy shit.


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Offlinelowbrow
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Re: Viral outbreak in China [Re: feevers]
    #26587057 - 04/08/20 06:44 PM (3 years, 10 months ago)

I misread it and thought you were implying it.  Sorry.

I cant say Ive seen any Trump supporters who think the corona virus is a hoax, but I’m not exactly looking for them either.


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Amanita86 said:
Sui is trying to mod right now.  Kinda like a newborn calf tryin ta stand fer the first time ain’t it..


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Offlinelowbrow
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Re: Viral outbreak in China [Re: tyrannicalrex] * 1
    #26587071 - 04/08/20 06:50 PM (3 years, 10 months ago)

Quote:

tyrannicalrex said:
It was a s.carolina rally.

Does this work?
https://www.politico.com/news/2020/02/28/trump-south-carolina-rally-coronavirus-118269




no.  That’s not a reliable source.  They paraphrased the supposed quote but it does not exist anywhere in that article.

I’ll go hunt it up.  Man, my bird’s starting to get pissed at me, I told him I’d clean his cage today and I’m procrastinating.

That’s an article from a month ago.  It’s talked about in the snopes link i published.


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InvisiblefeeversM
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Re: Viral outbreak in China [Re: feevers]
    #26587075 - 04/08/20 06:52 PM (3 years, 10 months ago)

A lot of nursing home staff aren't refusing to show up out of their own self-interest, they're staying home because their facility doesn't have the proper PPE or procedures in place to protect the elderly people, so it's inevitable the staff would get sick and spread it. Skilled nursing facilities typically have insanely high productivity standards and low staff ratios, and are constantly towing the ethical and even legal line. The MA government has said they have no advice or standards of care for nursing homes at the moment, these lives are in the hands of nursing home CEOs now essentially, what could go wrong?

I likely wouldn't show up either if my job was pretty much guaranteeing I'd spread the virus to such high risk people, and my company and/or government were not giving me the tools or ability to change that. Ethics can get ugly


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Offlinemorrowasted
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Re: Viral outbreak in China [Re: ShroomerInTheRye] * 1
    #26587079 - 04/08/20 06:54 PM (3 years, 10 months ago)

https://www.statnews.com/2020/04/08/doctors-say-ventilators-overused-for-covid-19/

With ventilators running out, doctors say the machines are overused for Covid-19

Even as hospitals and governors raise the alarm about a shortage of ventilators, some critical care physicians are questioning the widespread use of the breathing machines for Covid-19 patients, saying that large numbers of patients could instead be treated with less intensive respiratory support.

If the iconoclasts are right, putting coronavirus patients on ventilators could be of little benefit to many and even harmful to some.

What’s driving this reassessment is a baffling observation about Covid-19: Many patients have blood oxygen levels so low they should be dead. But they’re not gasping for air, their hearts aren’t racing, and their brains show no signs of blinking off from lack of oxygen.

That is making critical care physicians suspect that blood levels of oxygen, which for decades have driven decisions about breathing support for patients with pneumonia and acute respiratory distress, might be misleading them about how to care for those with Covid-19. In particular, more and more are concerned about the use of intubation and mechanical ventilators. They argue that more patients could receive simpler, noninvasive respiratory support, such as the breathing masks used in sleep apnea, at least to start with and maybe for the duration of the illness.

One reason Covid-19 patients can have near-hypoxic levels of blood oxygen without the usual gasping and other signs of impairment is that their blood levels of carbon dioxide, which diffuses into air in the lungs and is then exhaled, remain low. That suggests the lungs are still accomplishing the critical job of removing carbon dioxide even if they’re struggling to absorb oxygen. That, too, is reminiscent of altitude sickness more than pneumonia.


One problem, though, is that CPAP and other positive-pressure machines pose a risk to health care workers, he said.  The devices push aerosolized virus particles into the air, where anyone entering the patient’s room can inhale them. The intubation required for mechanical ventilators can also aerosolize virus particles, but the machine is a contained system after that.





CPAP/BiPAP were contraindicated at first due to lack of PPE and aerosolization of particles but I guess now that they have these wards were everyone is fully suited up they've changed that


more and more and more confirmation coming in that this is not primarily a lung problem. normal carbon dioxide levels mean that normal gas exchange is occurring at the alveoli, but patients are hypoxemic. this suggests we are dealing with a disease whose primary pathophysiology involves oxygen transport rather than gas exchange


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Offlinemorrowasted
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Re: Viral outbreak in China [Re: morrowasted] * 1
    #26587085 - 04/08/20 06:58 PM (3 years, 10 months ago)

https://www.the-hospitalist.org/hospitalist/article/220301/coronavirus-updates/protocol-driven-covid-19-respiratory-therapy-doing


Dr. Gattinoni noted that COVID-19 patients in ICUs in northern Italy had an atypical ARDS presentation with severe hypoxemia and well-preserved lung gas volume. ..


The bottom line, as Dr. Kyle-Sidell and Dr. Gattinoni agree, is that protocol-driven ventilator use may be causing lung injury in COVID-19 patients...

“Yet, COVID-19 pneumonia, despite falling in most of the circumstances under the Berlin definition of ARDS, is a specific disease, whose distinctive features are severe hypoxemia often associated with near normal respiratory system compliance,” Dr. Gattinoni and colleagues wrote, noting that this was true for more than half of the 150 patients he and his colleagues had assessed, and that several other colleagues in northern Italy reported similar findings. “This remarkable combination is almost never seen in severe ARDS.”

They identified two primary phenotypes based on the interaction of these factors: Type L, characterized by low elastance, low ventilator perfusion ratio, low lung weight, and low recruitability; and Type H, characterized by high elastance, high right-to-left shunt, high lung weight, and high recruitability....

“Given this conceptual model, it follows that the respiratory treatment offered to Type L and Type H patients must be different,” Dr. Gattinoni said.

Patients may transition between phenotypes as their disease evolves. “If you start with the wrong protocol, at the end they become similar,” he said...

“This is a kind of disease in which you don’t have to follow the protocol – you have to follow the physiology,” he said. “Unfortunately, many, many doctors around the world cannot think outside the protocol.”...


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Offlinemorrowasted
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Re: Viral outbreak in China [Re: morrowasted] * 1
    #26587097 - 04/08/20 07:03 PM (3 years, 10 months ago)

Kyle-Sidell: Yes. The patients in front of me are unlike any patients I've ever seen., and I've seen a great many patients and have treated many diseases. You get used to seeing certain patterns, and the patterns I was seeing did not make sense. This originally came to me when we had a patient who had hit what we call our trigger to put in a breathing tube, meaning she had displayed a level of hypoxia of low oxygen levels where we thought she would need a breathing tube. Most of the time, when patients hit that level of hypoxia, they're in distress and they can barely talk; they can't say complete sentences. She could do all of those and she did not want a breathing tube. So she asked that we put it in at the last minute possible. It was this perplexing clinical condition: When was I supposed to put the breathing tube in? When was the last minute possible? All the instincts as a physician—like looking to see if she tires out —none of those things occurred. It's extremely perplexing. But I came to realize that this condition is nothing I've ever seen before. And so I started to read to try to figure it out, leaving aside the exact mechanism of how this disease is causing havoc on the body, but instead trying to figure out what the clinical syndrome looked like.

https://www.medscape.com/viewarticle/928156



Edited by morrowasted (04/08/20 07:14 PM)


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Offlinemorrowasted
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Re: Viral outbreak in China [Re: morrowasted] * 2
    #26587111 - 04/08/20 07:10 PM (3 years, 10 months ago)

https://www.thennt.com/review-covid-analysis-april-2020/

EVIDENCE BITE: Airborne transmission is rare or non-existent, and much less important (in public health terms) than contact spread

SUMMARY: ‘Attack rate’ is often used to refer to the percentage of non-immune people who will fall ill if exposed to a person with an infectious disease. The measles attack rate is roughly 80-90%, which is why the 'R-naught' for measles is around 15—this is how many (non-immune) people will fall ill from every one person with measles, partly because it can be transmitted via airborne transmission.  While data demonstrate SARS-CoV-2 can be aerosolized into the air for hours in a laboratory, this is different from airborne transmission of illness.

Most importantly, the R-naught for Covid-19 is between 2 and 3 and international contact tracing efforts have shown low attack rates among close and even household contacts. In one typical tracing analysis by the CDC for instance, 10 persons actively ill with established, symptomatic Covid-19 had 'close contact' (<6 feet for >10 minutes) with 445 other individuals. A total of 2 additional people became ill from them. These 2 had household, extended contact, thus transmission rate was 10% among household (2/19) and 0% among other contacts (0/426).

While such numbers vary depending upon many factors, the term ‘airborne’ may be broadly misunderstood. The SARS-CoV-2 virus can be aerosolized by coughs, sneezes, and, according to some experts, perhaps even breathing or talking. However, the virus is pulled down by gravity and cannot be inhaled into the lungs causing infection (i.e. ‘airborne transmission’). If it could, the R-naught would likely be much higher, as with measles or chicken pox. It can, theoretically, touch someone’s face or mouth after being breathed out, and cause illness, though no cases of this have been demonstrated at this point. The virus can also be aerosolized during medical procedures which is why caution is critical for healthcare providers.

In summary, airborne transmission of Covid-19 illness is rare or non-existent, but aerosolized spread of the virus (like any virus) is feasible and could, rarely, lead to illness. Most importantly, avoiding close contact with even mildly ill persons, and using soap or sanitizers after contact with people or objects with any chance of viral contact, will keep people safe.

If You Have An Upper Respiratory Infection, How Likely Is It To Be Covid-19?

EVIDENCE BITE: Likely. We’re in the midst of a global pandemic of Covid-19, while influenza is waning in most parts of the country.

SUMMARY: The prevalence of Covid-19 in quarantines and among fever clinic testing has been surprisingly low. Moreover, most states’ testing numbers show low rates (10-30%) of SARS-Cov-2 among tested samples. This may be misleading, however, since asymptomatic people, and hospitalized patients with existing illnesses are included in testing groups. If only people with current URI symptoms in active pandemic countries were tested, the positive rate would likely be much higher. Based on current trends and disease activity in the United States a URI is more likely to be due to Covid-19 than any other cause.

Asymptomatic transmission may occur, and mildly symptomatic cases can certainly transmit the virus. However we agree with the United States CDC which states “this is not thought to be the main way” Covid-19 is spread, and with the Maria Van Kerkhove of the WHO, who says such events are “very, very few”, and “definitely not a major driver of transmission. However, as the world becomes increasingly aware of Covid-19 and its dangers, and people assiduously avoid symptomatic persons, asymptomatic spread may become proportionately more important.

Hydroxychloroquine:

As of April 1st we are aware of two randomized trials, neither published in a scientific journal. One pilot trial of hydroxychloroquine to improve viral testing results showed no benefit. A second trial report claims a difference of one day in ‘time to recovery’ favoring the drug over a control group with no mention of placebos. The trial’s registry entry, however, notes three groups (two different drug doses and a placebo), and two different primary outcomes (time to PCR test negativity and ‘T-cell recovery’) neither of which is mentioned. Based on this and other irregularities the paper is, at this point, not credible. More importantly, however, in the setting of a pandemic, during which we are seeking to stem a tide of mortality, reducing time to recovery in mild cases is clinically unimportant. The authors report, as an incidental finding, that four patients in the control group progressed to more severe disease, while none in the drug group did. This is the one promising note, and we hope it can be followed up with further research findings soon.

Evidence reviews of hydroxychloroquine for Covid-19 have been performed, and beyond the trials noted above there is no useful clinical data, only laboratory and viral load data that are variably unimpressive or disappointing.

Convalescent plasma: Therapy has been reported in 5 patients suffering severe, ventilated Covid-19, with disappointing results. Despite patients being non-elderly (mean age 60s) and largely healthy (zero comorbidities) two patients remained ventilated, and three came off ventilators only weeks after treatment.

Protease inhibitors (such as Lopinavir–Ritonavir): Despite great theoretical promise, protease inhibitors have failed to show a benefit in ‘time to improvement’ among 199 patients in China. They may reduce mortality slightly, based on a small difference favoring the drug (6% absolute difference, statistically nonsignificant), but this requires further study.

Nucleotide analogs: Remdesivir is a nucleotide analog which may block the viral replication. This antiviral was developed to treat ebola after successful in vitro findings but clinical trials showed conflicting results. Preliminary data have showed that remdesivir can slow the progress of MERS-COV infection in monkeys. This has paved the way for clinical trials to test remdesivir for COVID-19. As of April 1st, there at least 6 trials registered on clinicaltrial.gov that are recruiting patients for remdesivir COVID-19 trials. It is projected that some of these trials are going to complete recruitment and report their results in April.

Final note: The common cold remains unsolved, and no agent has been found to improve important outcomes for influenza. It is perhaps unsurprising then, that no current data support a Covid-19- therapy. We hope patients everywhere are being enrolled in trials to test these and other possibilities.


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Offlineimachavel
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Re: Viral outbreak in China [Re: feevers]
    #26587118 - 04/08/20 07:13 PM (3 years, 10 months ago)

Quote:

feevers said:
This was a nursing home near me the other day. Our governor sent in the national guard to test everyone.

Nursing homes that require hands-on care are in really rough shape right now.






Boston?


--------------------
:kingcrankey: I did not say to edit my signature soulidarity! Now forever I will never remember what I said about understanding the secrets of the universe by paying attention to subtleties!

:facepalm: I'm never giving you the password again. Jerk


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Re: Viral outbreak in China [Re: morrowasted] * 1
    #26587125 - 04/08/20 07:16 PM (3 years, 10 months ago)

That's pretty ugly if 99% of doctors are handling this wrong, and possibly causing further lung damage and even cognitive damage from ventilation/sedation

From a vent supply standpoint it'd be a relief if we weren't so reliant on them. Sounds like a push for early detection and intervention will be crucial, assuming we figure out the right drugs to use.


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InvisiblefeeversM
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Re: Viral outbreak in China [Re: imachavel] * 1
    #26587129 - 04/08/20 07:19 PM (3 years, 10 months ago)

Quote:

imachavel said:
Quote:

feevers said:
This was a nursing home near me the other day. Our governor sent in the national guard to test everyone.

Nursing homes that require hands-on care are in really rough shape right now.


Boston?



Yup


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Offlinemorrowasted
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Re: Viral outbreak in China [Re: feevers] * 3
    #26587180 - 04/08/20 07:49 PM (3 years, 10 months ago)

Quote:

feevers said:
That's pretty ugly if 99% of doctors are handling this wrong, and possibly causing further lung damage and even cognitive damage from ventilation/sedation

From a vent supply standpoint it'd be a relief if we weren't so reliant on them. Sounds like a push for early detection and intervention will be crucial, assuming we figure out the right drugs to use.




Hate to say it but ime most doctors operate out of protocol because it is easier and they are less likely to be held liable for poor outcomes.


Also they rely on the data we collect like a motherfucker in the ER. orders start flying in before the doctor has ever laid eyea on the patient just based on our phonecalls. Most of them just get into a kind of autopilot. You call em up and tell em a newly intubated patient just rolled in and before you can finish they are telling you the orders for roc and fent and versed are in the system and i wanna be like woah motherfucker slow down wait til i get to the part where i tell you shes on a fuckload of ketamine and lets see if you still wanna give her dose of roc

Anyway that really had nothing to with anything i am just deliriously rambling. Obviously some doctors are great and wonderful and brilliant


Ps all scenarios involving a patient depicted in this post are 100% fictionalized and not based on actual events


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